Medical malpractice: impact of the crisis and effect of state tort reforms.

As a result of rapidly rising medical malpractice insurance premiums, reduced availability of coverage, and financially distressed liability insurers, many states have passed tort reforms. This synthesis examines the medical malpractice ""crisis"" and the effect of state tort reforms. Evidence shows that caps on non-economic damages reduce the average size of malpractice awards by 20 to 30 percent and have a modest impact on malpractice insurance premium growth There is also evidence that the most severely injured patients are disproportionately affected by caps, however. Other state reforms such as changes to joint-and-several liability, statutes of limitations, or attorney contingency fees have had little impact. Studies do not support the notion that overall physician supply has decreased, nor that there is a relationship between malpractice cost and physician supply. There is ""good evidence"" that doctors ""often"" engage in defensive medicine, ordering referrals, medications and tests to protect themselves from liability, but the impact of this practice is difficult to quantify.